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Physicians’ accessory fees in Quebec

The Minister of Health and Social Services ("Minister") plans to amend Bill 20, An Act to enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation, to regulate the billing of accessory fees in private medical clinics and establish a list of permissible fees.

Currently, An Act Respecting the Régie de l'Assurance Maladie du Québec provides that doctors who practise in the public system can only charge patients for medication and anesthesia agents. Detailed billing was not required and questions have been raised concerning some extra fees that may have been charged by physicians.

The Régie de l'assurance maladie du Québec ("RAMQ") has investigated certain billing practices and the Collège des médecins du Québec (the "College") has also revised its Code of ethics of physicians.

The new Code of ethics of physicians provides that a physician may not claim disproportionate amounts as payment for the medical supplies required by the treatments administered.

There is much confusion as to what constitutes "disproportionate" amounts. In fact, several doctors may have contacted the College to obtain clarity.

The Minister tried to resolve the confusion. Minister Barrette announced that accessory fees or extra charges billed to patients cannot be more than twice the cost of the medication administered.

Generally, the amount charged to the patient should not exceed the acquisition cost of the medical supplies. If additional costs are charged, they must be a direct result of the activities that make the medical supplies accessible to the patient.

Examples of such costs include those associated with:

order of the supply, to the extent that such activity is complex, individualized or urgent;

storage or retention of the supply, to the extent that it requires costly or expensive equipment, which are specific and necessary for storage or conservation; and

the loss of part of the stored supplies, to the extent that such loss is not due to poor inventory management, accident or any other unusual event.

On the other hand, some physicians believe they need accessory fees to cover legitimate costs. For example, the Fédération des médecins omnipraticiens du Québec ("FMOQ") stated that increasingly services are provided out-of-hospital at physician's clinics and there is concern that if physicians cannot charge the actual cost of these services, they may stop offering them. FMOQ has thus maintained that either the government should cover the costs of these services or physicians should be allowed to charge.

It is for these reasons that Minister Gaétan Barrette recently announced his plan to amend Bill 20 in order to establish certain, permissible accessory fees.

In addition, on Tuesday, June 30th, 2015 the government of Quebec adopted a decree (PDF - available in French only) that provides for the deferral of some changes to the Code of ethics of physicians to an unspecified date. Notably the changes include those made to accessory fees.

The Minister has set up a committee, including representatives of the Ministry of Health, the Fédération des médecins spécialistes (the Federation of Medical Specialists) and FMOQ which will be accompanied by an accounting firm, to establish the parameters within which accessory fees may be charged by doctors.

It is expected that a price list will be drawn up and all other costs will not be permitted. There is no firm date yet for the committee, but it seems this matter will be a priority when the National Assembly returns in August.

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